Lyme Disease- Recurrence or Reinfection?

Lyme disease, an illness that can be quite serious if left untreated, affects people living in many parts of the United States. Since it was described in 1975 after being identified in Lyme, CT, the infection has grown in both real frequency and myth.  Tranmitted by the tick Ixodes scapularis, commonly known as the deer tick, the causative organism is Borrelia burgdorferi, a type of bacteria. Following attachment by the tick, 24 to 36 hours are required for B.burgdorferi to be transmitted to its host, and often a characteristic rash known as erythema migrans develops at the site of tick attachment.  Now there's good news, as Rick and I discuss this week on PodMed: turns out that contrary to much popular opinion and the word on the street, most if not all cases of recurrent Lyme disease in people who've already had it and been treated are new infections, not recrudenscence of an existing infection. That's as reported in the New England Journal of Medicine.  So why is that good news? First let's take a look at the study.

A total of 17 patients in whom there were 22 paired consecutive  episodes of erythema migrans were reported in this study. Specimens of skin and blood were obtained from each patient and the organism cultured and genotyped. Additional molecular tests were also performed on the specimens.  Interestingly, only 27% of the subjects recalled a tick bite at the site of erythema migrans development in the previous 30 days.

The same genotype was not identified in any of the paired infections, indicating clearly that each episode was caused by a different strain of the bug.  Additional factors such as the time of year during which infection occured and the length of time between infections were consistent with this conclusion. The take home message for people who receive a diagnosis of Lyme disease is that when they complete their antibiotic treatment, they can feel confident the infection has been eradicated and not worry about the constellation of negative sequelae that can develop when an infection isn't properly diagnosed and/or treated. YAY!

Lyme disease, of course, has a lot of panic attached to it among many, and that's because the symptoms of tertiary disease are dire indeed.  Thus rabid advocacy groups have stridently proclaimed that Lyme requires a complex and prolonged treatment course during which hypervigilance is required.  Maybe now that this study has been published some of the fever will die down.  It is true, as Rick points out in the podcast, that sometimes even when the treatment course has been completed and the organism eradicated, symptoms such as arthritis, that may be severe, remain.  The current explanation for this seems to be that Borrelia ramps up the immune response, which then takes some time to return to baseline.  Tough for those who are living with it to deal with but much less serious than disseminated Lyme.

Other topics this week include steroid injections for sciatica, fungal infections secondary to steroid injection, and probiotics for Clostridium difficile infection, all in Annals of Internal Medicine.  Until next week, y'all live well.

 

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Carin August 11, 2013 at 2:56 am

Yes, use the test for the presence of the Borrelia Burgdorferi bacteria. I have had god experience with this test and it's not very expensive either. And, as Amy, said, have it usually take a couple of days before the test results are available. Anyway, have anyone heard about the new borrelia biofilms? I have read about this on a couple of lyme blogs but never really understood what they are all about. If someone has more info, please post it here. And what happened to the Lyme petition? Anyone knows?

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Mike January 30, 2013 at 1:47 pm

There is a Lyme petition at the following address:
https://petitions.whitehouse.gov/petition/reform-infectious-disease-society-america-treatment-guidelines-lyme-disease/Pj9jG0pX

The petition will only be up until 2/10/13, and we need 25,000 signatures for the White House to review and respond.

This is the best chance for raising Lyme awareness I have seen, so please spread the word!

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Kathy O'Malley December 29, 2012 at 10:06 am

Why is it necessary to classify LD advocacy groups as "rabid"? Wouldn't "earnest" or "zealous" be somewhat less perjorative? Just seems like another example of the tendency to demonize those who disagree, whether it's in politics or Lyme Disease.

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Amy December 14, 2012 at 9:37 pm

First, you need to identify the tick. If it peorvs to be a deer tick (aka: black-legged tick) officially refered to as Ixodes scapularis', you can proceed with pursuing testing for Lyme, though any imbedded tick of this type found on you in an area where Lyme is a problem, should be considered a high-risk bite that most likely needs immediate antibiotic therapy (Don't Wait for the test results, Olga! See your doc NOW!)As far as getting that Tick tested, either look up or call your local county's Dept. of Health Human Services. Also, a call to the nearest University's Co-op Extension Service is often fruitfull.There is usually atleast One lab in each state in the Northeast U.S. that will test the tick [for the presence of the Borrelia Burgdorferi bacteria] but they usually charge somewhere around $45 to $75/ tick often only accept the ticks via express shipment at the beginning of the week. You can usually order up a kit in advance to ship the sick tick to em.Don't expect the results right away it takes a few days to over a week. That's it!

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